The Ministry of Health and Long-Term Care (MOHLTC) recently revealed an expanded HPV immunization program for school children across Ontario. Minister of Health and Long-Term Care, Dr. Eric Hoskins, announced the decision explaining “helping to protect Ontarians against cancer is part of our government’s plan to build a successful and vital province. Expanding access to the HPV vaccine to include boys is an evidence-based decision and it is the right thing to do”. The Medical Station discusses HPV, the importance of vaccination, and the debate surrounding the immunization program expansion.
Human papillomavirus, also known as HPV, is the most common sexually transmitted infection. There are over 100 different types of HPV, each with varying risk profiles. The two highest risk types of the virus are HPV-16 and HPV-18. These two strains are responsible for 70% of cervical cancers and are also linked with ano-genital cancers, head and neck cancers, and genital warts.
The health burden of HPV is significant – every year there are 254 HPV related deaths, 1,090 new cases of cancer attributable to HPV, and 14,666 new cases of genital warts attributable to HPV in Ontario.
The HPV Vaccine
The HPV vaccine is extremely effective in preventing most types of HPV. The Public Health Agency of Canada (PHAC) estimates that in the absence of vaccination, 75% of sexually active Canadians will have a sexually transmitted HPV infection at some point.
There are two vaccines currently approved by Health Canada, Gardasil and Cervarix. The National Advisory Committee on Immunization (NACI) states that the vaccine is most effective when received at a young age, prior to the onset of sexual activity. The HPV vaccine can be given in a 2 or 3 dose schedule, with a few months in between injections.
Ontario’s New HPV Immunization Program
Since 2007, the MOHLTC has offered the HPV vaccine, Gardasil, to girls in grade 8 through school based clinics and local public health units.
Beginning in the 2016-2017 school year Ontario is expanding the publicly funded immunization program to include boys, they will also start offering the vaccine in grade 7 (instead of 8) . The MOHLTC explains that “this change aligns with current scientific and expert recommendations to help protect more youth against HPV”. Approximately 154,000 school-aged youth will be eligible under this expanded program.
Ontario will now be joining Alberta and PEI as the only other provinces which offer publically funded HPV vaccines to boys. Manitoba will be following suit this fall as well. Vaccinating boys in addition to girls will work to further increase the effectiveness of the HPV vaccine, as higher levels of immunity are achieved - thus reducing the incidence of HPV attributable cancers in both males and females.
The switch from grade 8 to grade 7 will make Ontario’s program more consistent with the other provinces and territories which offer the vaccine earlier. Additionally, this is more in line with the recommendations that the HPV vaccine should be given to children between the ages of 9-13.
The Debate Surrounding the HPV Vaccine
The question of whether or not to include boys in the publicly funded school-based HPV immunization program has been discussed at great lengths. Healthy Debate provides an in depth look at this question. Some of the arguments against the expansion of the program include an insufficient cost-benefit ratio and the risk that expansion of the vaccination program will encourage an early onset of sexual activity. Some of the arguments in favour of the expansion include economic feasibility, increased protection for men, particularly men who have sex with men, and achieving herd immunity (which isn’t always achieved by exclusively vaccinating girls).
Lessons from Rubella
Rubella is a typically mild viral infection which results in fever, sore throat, swollen glands, and a rash. It is can become quite dangerous, however, when pregnant women get infected as it can cause birth defects.
From 1968-1969 Canadian provinces took two different approaches to Rubella vaccination. Some followed the American model of widespread immunization, whereas others followed the British model of selectively vaccinating girls and at risk women. By 1988 however, British authorities had switched to the American approach, acknowledging that vaccinating boys was indeed necessary to successfully prevent and eradicate rubella in their population.